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Öğe Anesthetic approach to adult moyamoya disease: A case report(Gulhane Askeri Tip Akademisi, 2010) Said Aydo?an M.; Yücel A.; Özgül U.; Öztürk E.; Konur H.; Namik Öztanir M.; Özcan Ersoy M.Moyamoya disease is an entity, which is caused by obstruction or stenosis in the area between the internal carotid artery, and anterior and middle cerebral arteries, identified angiographically, and does not have an exactly known etiology. The most frequent symptoms of onset are hemorrhage in adults and ischemia in children. In the treatment of moyamoya disease revascularization surgery is performed in order to decrease the vascular fragility. A specialized care is required in the perioperative period since surgery is often complicated by cerebral ischemia or cerebral hemorrhage. Aim in the perioperative anesthetic management is to provide the balance between oxygen supply to and use in the brain. In this case report we aimed to discuss the anesthetic management in a 22-year-old male patient with moyamoya disease in whom a multipl burr hole surgery was performed. © Gülhane Askeri Ti{dotless}p Akademisi 2010.Öğe The comparison of hemodynamic effects of remifentanil or fentanyl addition to midazolam infusion for total intravenous anesthesia in coronary artery bypass surgery(2004) Köro?lu A.; Gedik E.; Gülhaş N.; Toprak H.I.; Karaaslan K.; Özcan Ersoy M.We aimed to determine the effects of remifentanil or fentanyl infusion with midazolam on response to endotracheal intubation, surgical stimulus and intraoperative hemodynamics in coronary artery bypass surgery. Anesthesia was induced with thiopental sodium 0.5-3 mg kg-1 and 2 ?g kg-1 remifentanil (Group R, n=31), or 15 ?g kg-1 fentanyl (Group F, n=29) in 60 cases included into the study. Anesthesia was maintained with 1 ?g kg-1 min-1 remifentanil in group R or 0.15 ?g kg-1 min-1 fentanyl in group F in addition to the midazolam infusion 0.15 mg kg-1 h-1. Mean arterial pressure (MAP), heart rate (HR) were recorded at 1, 3 and 5 min after intubation and surgical stimulus and 5 min intervals during surgery. Also time to intubation and complications were recorded. Heart rate was lower in group R after anesthesia induction. During opioid infusion both MAP and HR decreased more in group R than F. After skin incision, sternotomy and internal mamarian artery dissection MAP and HR were higher in group F than R. Hypertensive response to sternotomy, skin incision, internal mamarian artery dissection was less in group R than group F. Frequency of hypertension and requirement of nitroglycerin were lower in group R than group F during CPB. We concluded that thiopental sodium with remifentanil or fentanyl in anesthesia induction did not prevent the hypertensive response to intubation. However maintenance with remifentanil and midazolam infusion was more effective in preventing surgical stimuli.Öğe The Effects of Sevoflurane and Propofol on Induction, Maintenance and Recovery in Elderly Patients(2003) But A.K.; Durmuş M.; To?al T.; Gedik E.; Yücel A.; Özcan Ersoy M.In this study, we aimed to compare the effects of sevoflurane and propofol on induction, maintenance and recovery in elderly patients. Forty patients, ASA class I-II, more than 60 years of age, undergoing elective surgery that last between 2-4 hours were taken into the study. Anaesthesia was induced with 66 % N2O and 7 % sevoflurane in the group S (n=20) and 1-2 mg kg -1 propofol approximately within 30 seconds in the group P (n=20). In the two groups; loss of consciousness, loss of eyelid reflex, time to intubation, adverse effects during induction, heart rate (HR) and mean arterial pressure (MAP) after first, third and fifth minutes of induction were recorded. Maintenance of anaesthesia was provided with 66 % N2O and 1-4 % sevoflurane in group S, 2-10 mg kg -1 h-1 propofol and 66 % N2O in group P. HR and MAP values were determined after first minutes of intubation until the end of the operation. At the end of operation after discontinuation of anaesthetic agents, times to extubation, eye opening, verbal response, orientation and Aldrete score >8 were recorded. The only difference is that induction time was shorter significantly in the group P (p<0.05). Sevoflurane and propofol recovery times and postoperative complications were similar in ASA I-II, elderly cases undergoing elective surgery. Although its hypotensive effect was prominent, induction was faster with propofol. We concluded that both of sevoflurane and propofol can be used safely for ASA I-II elderly patients, if the dose of propofol decreased and given slowly.Öğe Haemodynamic effects of isoflurane and sevoflurane in pulmonary hypertensive mitral valve stenosis(2002) Kadir But A.; Türköz A.; Durmuş M.; Toprak H.I.; Çolak C.; Özcan Ersoy M.Although isoflurane and sevoflurane are widely used in cardiac surgery for their clinical properties, sufficient studies on their cardiovascular and pulmonary effects in mitral stenotic patients with pulmonary hypertension have not been found. Forty patients with mitral stenosis and pulmonary hypertension, who were undergoing mitral valve replacement surgery, were randomly divided into Isoflurane (Gi, n=20) and Sevoflurane (Gs, n=20) groups. After anaesthesia induction, the maintenance of anaesthesia was provided with 1 MAC izoflurane in Gi and 1 MAC sevoflurane in Gs. Hemodynamic measurements, central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI), were performed before anaesthesia induction (t0), after intubation (t1), and just before cardiopulmonary bypass (t2). Heart rates (HR) and mean arterial pressure (MAP) were also determined t0, t1 and t2 as well as during incisron (ti) and sternotomi (ts) In inter-group evaluation, HR were found to be different at t2 (p<0.05). In-group evaluation, there was statistically significant decrease at t2 compared to t0 in Gs. Inter-group evaluation revealed no significant difference in the other hemodynamic measurements. In-group evolution, MAP, MPAP, PCWP and CI decreased at t1 and t2 compared to t0 in both groups, but CVP declined only at t2 compared to t0. As a result, 1 MAC isoflurane and sevoflurane used in mitral stenotic patients with pulmonary hypertension caused a decrease in MAP, MPAP, and CVP, which is not necessary to be corrected and the decrease in CI was clinically acceptable. According to results of the study, both agents have been thought to be convenient to be used in patients with mitral stenosis with pulmonary hypertension.Öğe The Postoperative Analgesic Effects of Celecoxib and Rofecoxib in Total Abdominal Hysterectomy(2003) Durmuş M.; Köro?lu A.; Demirbilek S.; Özgül Ü.; Özcan Ersoy M.Celecoxib and rofecoxib that have been used in our country for treatment of osteoartritis and rheumatoid artritis are two COX-2 selective inhibitor non-steroidal antiinflammatory drugs. The aim of this study is to investigate postoperative analgesic and morphine sparing effects of single dose celecoxib or rofecoxib which were given before surgery in patients undergoing total abdominal hysterectomy. After obtaining approval from Ethics Committee, we studied 60 ASA I-II females undergoing total elective abdominal hysterectomy in a randomised, placebo controlled, double blind study. Patients were divided into 200 mg celecoxib (Group I, n=20), 50 mg rofecoxib (Group II, n=20) and placebo (Group III, n=20) groups. Anaesthesia was induced with 1.5 ?g kg -1 fentanyl, 4-6 mg kg-1 thiopental and 0.1 mg kg -1 vecuronyum. Morphine consumption, VAS scores at rest, on movement and on coughing and degree of sedation were evaluated during postoperative 2nd, 4th, 8th, 12th, and 24th h. Total morphine consumption was lesser in Group II at 8th h compared to Group III and at 12th and 24th h compared to Group I and III (p<0.05). VAS scores at rest, on coughing in Group I and II were significantly decreased during the first 24 h. There are no statistically significant differences between three groups regarding adverse effects. Although both celecoxib and rofecoxib produced a significant decrease in morphine consumption and VAS scores at rest, on movement and on coughing, we concluded that rofecoxib could produce better analgesia in early postoperative period and could decrease morphine consumption after 12th h with its long term effect.
